We talk about the years biggest medical stories with Dr. Marc Siegel, an Associate Professor of Medicine and a Fellow in the Master Scholars Society at New York University School of Medicine.

ALISON STEWART, host:

You are listening to THE BRYANT PARK PROJECT from NPR News. We are on digital, FM, AM, satellite, iTunes and online at npr.org/bryantpark. I'm Alison Stewart.

Thank you so much for spending your last day of '07 with me. Coming up, the science of happy. But first, a little medical science, from flesh-eating bacteria to leaden toys, it has been quite a year for medical stories. We want to take this last day of the year to look back at some of the biggest stories that possibly affected your health, and take a few moments, look ahead at what could be the big med stories in '08.

So joining us now is Dr. Mark Siegel. Dr. Siegel is an associate professor of medicine and a fellow in the Master Scholar Society at New York University School of Medicine. He's also a columnist for the L.A. Times.

Hi, Doctor.

Dr. MARK SIEGEL (Associate Professor, New York University): Good morning, Alison. How are you?

Dr. SIEGEL: Yeah. I know that. But, you know, part of the reason for that though is that even though we've had many scary stories this year in medicine, a lot of it has been exaggerated in the sense of would it affect you and me? When you talk about flesh-eating bacteria, that's actually an old story. That's been around for about 20 years. So we kind of dusted it off and gave it a new name this year, the super bug.

So in other words, we have to change our filters to some extent because sometimes we point to stories that are really a major problem and sometimes, we make them out to be more than they are. Probably the biggest medical story this year that hasn't even been talked about is the issue of medical tourism. That more and more people are going outside of the United States to get their medical care.

STEWART: Let's back up. First, I want to talk about the MRSA, which a lot of people call this flesh-eating bacteria, had parents frantically dipping their kids entire with some Purell before sending them off.

You know, a lot of the discussion about whether it was in schools or locker rooms, generally where do people contract this?

Dr. SIEGEL: Well, first of all, 85 percent of that bacteria is actually found in hospitals. And it's a major problem in hospitals and has been for about 10 or 20 years.

There's many reasons for that. One, we over-prescribe antibiotics. Two, we don't get as many new antibiotics made as we used to. The drug companies don't make a big profit on that so they're not making as many antibiotics. Three -and this is the part you were getting to - we don't use enough precautions. So we tend to promote these bugs, because we're not washing our hands frequently enough. We're not keeping our equipment clean. It's mainly in hospitals.

In the community, there's a new version of it, but it's mainly gyms and areas where there's a lot of close contact like that. And one idea that we need to dispel here is it's not a bug that's rapidly spread from one person to another. You know, I had a call once from a school system that was going to close down because of a pneumonia that was spreading around, and they said, we're using the same precautions here that we use for MRSA. And I said, you should use better precautions because the pneumonia spreads like wildfire. The MRSA requires very careful infectious disease precautions but does not spread as easily.

STEWART: Well, let's get to that idea of intercontinental medicine. Two stories: The medical tourism, but also drug importation, people getting their meds overseas because quite frankly, they're just cheaper. Even though they're cheaper, are they as safe?

Dr. SIEGEL: Well, first of all, that's two extremely important stories. You know, overseas, in Europe, you're allowed to export and import between countries. That drives the prices down. It's really pretty alarming that we make our top prescription drugs here in the United States from scratch. We discover them, we promote them, we make the products. And then we pay like three or four times greater prices than they pay overseas. That's largely because we can't re-import our drugs. And I think that that's really a governmental disgrace to some extent.

On the other hand, you know, importing drugs, you're right. There's a lot of counterfeit drugs out there. So it's hard to make sure they keep quality when we import drugs. Then, as we're busy re-importing drugs, we're also busy going overseas for our medical care. I tend to think of that as a mistake because even though there's a lot of great centers overseas, it's hard to know what you're getting. I mean, you can say we have accreditation.

This is accreditation, you know, that's through the same hospital accreditation, but when you're on foreign soil, it's a lot harder to know what you're getting. You can't network. You're stuck if something goes wrong. So I'm hesitant to really endorse that as a policy. I think we still have some of the best medical centers in the world here. (unintelligible) short-shrifting them.

But it is kind of a wake-up call to the idea, Alison, that we have to find a way to preserve quality of care in the United States. It isn't just about extending to more people. We certainly need to extend care to more people. We have 40 million uninsured and another 40 million underinsured. We have to solve that problem now.

STEWART: Yeah. You think that health care issues are going to be - the health insurance issues are going to be the big issue in '08, right?

Dr. SIEGEL: There's no question because of the campaign. But, you know, it's really two issues on the table, not just one: how do we extend care and how do we maintain quality of care at the same time? I mean, don't forget we already have a managed care environment where we're cutting down doctor's visits to six minutes. I mean, what can you do with six minutes? It's very, very little.

STEWART: Mm-hmm.

Dr. SIEGEL: So, you know, I don't see insurance company extension as the solution here. I'm much more interested in extending governmental involvement in terms of providing more care. I happen to think that right now - and this is going to be a pretty unpopular position - but I think Medicare is probably our best insurance right now. So instead of destroying it or changing it or extending managed care insurance, I think that that's likely the dilute quality of care…

STEWART: All right. You can send those e-mails to Dr. Siegel. That's S-I-E-G-E-L, NYU for if you want to get political.

I want to get this one more thing.

Dr. SIEGEL: (Unintelligible)

STEWART: And because, you know, there's always some movie that has some medical theme that just scares people and freaks them out. This year it was this movie called "Awake," that talked about anesthetic awareness where you're not completely under - you can see and feel everything. Let's play just a little bit of that trailer because it still scares me.

(Soundbite of movie, "Awake")

Mr. HAYDEN CHRISTENSEN (Actor): (As Clay Beresford) Oh, that's (unintelligible). What is going on? What is that? That stinks. Wait, am I supposed to be able to still hear you?

STEWART: So, doctor, when a movie like this comes out, did your phone start ringing?

Dr. SIEGAL: You bet. And I actually wrote about this movie for the L.A. Times, so it made my phone ring about five times more. You know, Alison, it's one of those complicated issues because it is a problem. It is an underappreciated in the United States. But here again, when Hollywood got a hold of it, it told it in a way where it was completely exaggerated. Nobody actually is there - from the mask to the end of the operation - awake.

Also, that in this movie, the guy was feeling a lot of pain, which is almost impossible in cardiac surgery. So even though it's a major issue, it's not a reason not to go for surgery. As I said in the column, you're much more likely to get into a problem on the L.A. freeway than you are to have a problem during anesthesia. So you have to see things in perspective.

STEWART: Well we're going to get our hands on that column and link to it on our blog.

Dr. Marc Siegel, an associate professor of medicine and a fellow in the Masters Scholar Society at NYU Medical School, a columnist for the L.A. Times.

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